Rachel Jones, Executive Director Strategy and Population Health at K&M CCG and Ray Savage, Strategic Partnerships Manager (Kent & Medway, East Sussex) at South East Coast Ambulance Service NHS Foundation Trust) were present for this item. Claire Hall, Specialist Paramedic (Urgent and Emergency Care), Clinical Pathways Lead, South East Coast Ambulance Service NHS Foundation Trust was in virtual attendance.
1. The Chair welcomed the speakers and asked Ms Jones to introduce the item. She provided a brief history, citing a CCG decision 3 years ago that was placed on hold pending the outcome of 2 Judicial Reviews and a referral to the Secretary of State. Those outcomes had been finalised and the proposal to create three HASUs in the County could be implemented.
2. During the three-year pause, stroke services had needed to be consolidated on three sites (Dartford, Maidstone and Canterbury). That arrangement had contributed to the rating of stroke services improving across Kent and Medway. She was clear that the three temporary sites were not HASUs, which would now begin to be implemented and were due to improve care even further.
3. Mr Savage gave an overview of ambulance response times. Stroke patients fell under category 2 calls, and nationally those response times during the pandemic had not been good, though SECAmb had performed relatively well. Response times were improving, and the Business Intelligence team analysed response times daily along with mapping future demand.
4. Ms Hall spoke about the innovation and change experienced within SECAmb. The introduction of telemedicine for example had resulted in around 50% of patients that would previously have been sent to a stroke unit be diverted to alternative provision. That change in patient flow had allowed stroke patients to be seen by a specialist quicker, thus reducing the “door to needle” time. Members were concerned that there could be misdiagnoses but Ms Hall provided reassurance that steps were in place to reduce the chance of this happening (for example governance meetings reviewing individual cases). Ms Jones confirmed that all stroke patients would go directly to a specialist unit and not through an A&E department. The long-term vision was for each HASU to be available 24 hours a day 7 days a week but this was not the case currently due to workforce constraints.
5. University College London (UCL) had carried out an in-depth 2-year evaluation into the use of telemedicine and the early data supported the view that no patient harm had occurred and that response times had improved.
6. A Member asked if telemedicine was replacing the need for a scan to confirm diagnosis. Ms Jones confirmed that was not the case – before telemedicine, the first contact with a specialist used to be once the patient arrived at hospital. Now, there was an early conversation between a doctor and a patient which allowed the doctor to eliminate stroke imitations. Scans would always be used for those suffering from a suspected stroke. Ms Hall explained that if a paramedic could not make contact with a stroke doctor the patient would be taken to a stroke unit.
7. Ms Hall suggested a stroke doctor provide a briefing for Members to provide assurance about the telemedicine system. Where the FAST assessment (Face, Arms, Speech, Time) was inconclusive, guidance was being updated accordingly.
8. Concerned about costs for families in visiting stroke patients, Members asked what work was being done to support this group. Ms Jones acknowledged the concerns and explained that three travel advisory groups would be re-established across Kent and Medway. Residents would be listened to and strategies put in place to address concerns.
9. Ms Jones explained that there was an active Patient Participation Group (PPG) and liaison with Healthwatch. Whilst the focus had been on the implementation of the HASUs the overall aim was to improve stroke care.
10.A Member drew the Committee’s attention to the performance metrics included in the agenda pack, in particular the improvement of Darent Valley Hospital from a D to a C rating, compared to Maidstone Hospital and East Kent Hospitals where the rating had improved to an A. Ms Jones answered that there was no definitive answer but factors included infrastructure constraints; Dartford seeing an increase in patients from London as hospitals in that region faced pressure; and workforce availability. In particular, Maidstone Hospital and Kent and Canterbury Hospital had benefited from a consolidation of staffing from other sites within those Trusts – Darent Valley was the only acute hospital under that provider. Ms Jones committed that within six months of HASUs being operational, each of the three units would be A rated (this would be evident after 9 months due to 3 month lag in data, so December 2023).
11.Asked why the Kent and Canterbury Hospital had been used as a stroke unit during the pandemic, Ms Jones explained that it was deemed the safest location for patients because it was being maintained as a covid-free site. It was not suitable as a long term solution because it did not have the necessary co-located services.
12.RESOLVED that the report be noted and the CCG be invited to return with an update at the appropriate time.